Over-the-Counter Medications for Flu Symptom Management
For symptomatic relief of flu, use acetaminophen or ibuprofen for fever and pain control, but avoid aspirin in anyone ≤18 years due to Reye's syndrome risk. 1
Antipyretic and Analgesic Options
Acetaminophen (Paracetamol)
- Standard adult dosing: 650-1000 mg every 4-6 hours (maximum 4 doses/24 hours) 2
- Effective for fever reduction and relief of headache, body aches, and general discomfort associated with flu 3
- Reduces body temperature by approximately 1.3°C within 4 hours at 1000 mg dose 3
- Well-tolerated with minimal adverse effects when used at recommended doses 3
Ibuprofen (NSAID)
- Standard adult dosing: 400-600 mg every 6-8 hours (maximum 3 doses/24 hours) 1
- Comparable efficacy to acetaminophen for fever and symptom relief 3
- Reduces body temperature by approximately 1.7°C within 4 hours at 1000 mg dose 3
- May provide superior relief for inflammatory symptoms like body aches 4
Combination Therapy
- Acetaminophen plus ibuprofen provides 2.5-4.4 additional hours without fever compared to single agents 5, 6
- Combined therapy achieves faster fever clearance (23 minutes faster than acetaminophen alone) 5
- Particularly effective for bacterial-origin fever, showing superior response at 1 hour compared to acetaminophen alone (48.6% vs 33.6% achieving primary endpoint) 4
- Critical caveat: Parents must carefully record all dose times to avoid exceeding maximum recommended doses, as 8-11% inadvertently exceed limits 5
Critical Safety Considerations
Aspirin Contraindication
- Never use aspirin or aspirin-containing products (e.g., bismuth subsalicylate/Pepto-Bismol) in anyone ≤18 years with suspected influenza due to Reye's syndrome risk 1
Pediatric Considerations
- Children <4 years should not receive OTC cold medications without healthcare provider consultation first 1
- For children 6 months to 6 years: ibuprofen 10 mg/kg per dose every 6-8 hours OR acetaminophen 15 mg/kg per dose every 4-6 hours 5
What OTC Medications Do NOT Treat
OTC symptomatic medications do not shorten illness duration, prevent complications, or reduce mortality—they only provide symptom relief 1, 7. For these outcomes, prescription antivirals (oseltamivir, zanamivir) are required and must be started within 48 hours of symptom onset 1, 8, 9.
When Antibiotics Are NOT Indicated
- Previously healthy adults with uncomplicated influenza or acute bronchitis do not require antibiotics 1
- Antibiotics should only be considered if secondary bacterial infection develops, indicated by: recrudescent fever after initial improvement, increasing dyspnea, new focal chest signs, or failure to improve after 2 days 1
Cost-Effectiveness
Combined acetaminophen/ibuprofen therapy is actually the most cost-effective option for both healthcare systems and families due to reduced healthcare service utilization (£14 vs £18-20 for single agents), despite higher medication costs 5